Lewis and Clark County covers 3,497 square miles in west-central Montana on the eastern slopes of the Continental Divide. Almost half of county residents live within the city limits of Helena, the county seat and the state capital, in the sixth most populated of Montana’s 56 counties. Between 2010 and 2014, the county’s only hospital, St Peter’s Health, saw 26,829 emergency room visits associated with substance use and 16,881 hospital admits. Jail-specific and county-specific data is difficult to access, and firsthand observations paint a stark picture of the growing and unmanageable OUD epidemic in Lewis and Clark County. The county hopes to provide MAT in the detention facility and implement direct connections to community-based treatment providers.